Prevention of laparoscopic surgery induced hypothermia with warmed humidified insufflation: Is the experimental combination of a warming blanket synergistic?

Abstract

INTRODUCTION:

Maintaining normothermia during anesthesia is imperative to provide quality patient care and to prevent adverse outcomes. Prolonged laparoscopic procedures have been identified as a potential risk factor for hypothermia, due to continuous insufflation of cold and dry carbon dioxide. Perioperative hypothermia is associated with increased hospital cost and many complications including; impaired drug metabolism, impaired immune function, cardiac morbidity, shivering, coagulopathy.

METHODS:

In this experimental study, four pigs underwent four interventions each, resulting in 16 total trials. Using standardized general anesthesia in a randomized Latin-square sequence the four interventions include: 1. Control group without an administered pneumoperitoneum, 2. Administered standard pneumoperitoneum using 21°C insufflated gas and under-body forced-air warming, 3. Administered pneumoperitoneum with insufflation of warmed/humidified carbon dioxide, 4. Administered pneumoperitoneum with insufflation of warmed/humidified carbon dioxide and under-body forced-air warming. The primary outcome was distal esophageal temperature change 4 hours after trocar insertion.

RESULTS:

Four hours after trocar insertion, pigs in the control group lost 2.1 ± 0.4°C; pigs with warmed and humidified insufflation lost 1.8 ± 0.4°C; pigs with forced-air warming group lost 1.3 ± 0.9°C; and pigs exposed to a combination of warmed and humidified insufflation with forced-air warming increased by 0.3 ± 0.2°C.

CONCLUSION:

This experimental animal study provides evidence that a combination of warmed and humidified insufflation of carbon dioxide (CO2) in conjunction with forced-air warming is an effective strategy in the prevention of perioperative hypothermia. Further clinical trials investigating humans are therefore indicated.

• Authors: Eric Noll, Sophie Diemunsch, Julien Pottecher, Jean-Pierre Rameaux, Michele Diana, Eric Sauleau, Kurt Ruetzler, Pierre Diemunsch
• Journal: PloS one (PLoS One) Vol. 13 Issue 7 Pg. e0199369 ( 2018) ISSN: 1932-6203 [Electronic] United States
• PMID: 29995891 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Animals
• Humans
• Humidity
• Hypothermia (etiology, prevention & control)
• Insufflation (methods)
• Laparoscopy (adverse effects, methods)
• Male
• Swine
• Temperature